secure.lebleubnb.com Open in urlscan Pro
2606:4700:3033::6815:3c61 Public Scan

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URL:
https://secure.lebleubnb.com/
Submission: On July 10 via automatic, source certstream-suspicious (July 10th 2024, 10:16:17 am UTC) — Scanned from DE

Form analysis
1 forms found in the DOM

POST process-form.php

<form role="form" id="formSecurePayment" class="form-horizontal bv-form" action="process-form.php" method="post" data-bv-submitbuttons="button[type=&quot;submit&quot;]" data-bv-live="enabled" data-bv-feedbackicons-valid="glyphicon glyphicon-ok"
  data-bv-feedbackicons-invalid="glyphicon glyphicon-remove" data-bv-feedbackicons-validating="glyphicon glyphicon-refresh" novalidate="novalidate"><button type="submit" class="bv-hidden-submit"
    style="display: none; width: 0px; height: 0px;"></button>
  <input type="hidden" name="g-recaptcha-response" value="">
  <h1 class="text-center">Secure Payment Form</h1>
  <p align="center">Please use this form to securely transmit your credit card details to Le Bleu BNB.<br>All information is encrypted using SSL to ensure safe transmission.</p>
  <h3><i class="fa fa-fw fa-user"></i>Contact Details</h3>
  <div class="form-group has-feedback">
    <label class="col-sm-3 control-label"> Full Name</label>
    <div class="col-sm-4"><input type="text" class="form-control" id="txtFirstName" name="txtFirstName" placeholder="First name" autocomplete="on" data-bv-notempty="true" data-bv-notempty-message="Your first name is required"
        data-bv-field="txtFirstName"><i class="form-control-feedback" data-bv-icon-for="txtFirstName" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtFirstName" data-bv-result="NOT_VALIDATED"
        style="display: none;">Your first name is required</small></div>
    <div class="col-sm-5"><input type="text" class="form-control" id="txtLastName" name="txtLastName" placeholder="Last name" data-bv-notempty="true" data-bv-notempty-message="Your last name is required"
        data-bv-field="txtLastName"><i class="form-control-feedback" data-bv-icon-for="txtLastName" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtLastName" data-bv-result="NOT_VALIDATED"
        style="display: none;">Your last name is required</small></div>
  </div>
  <div class="form-group has-feedback">
    <label for="txtEmail" class="col-sm-3 control-label">Email</label>
    <div class="col-sm-9"><input type="email" class="form-control" id="txtEmail" name="txtEmail" placeholder="Your email address" autocomplete="on" data-bv-notempty="true" data-bv-notempty-message="Your email address is required"
        data-bv-emailaddress="true" data-bv-emailaddress-message="The email is not valid" data-bv-field="txtEmail"><i class="form-control-feedback" data-bv-icon-for="txtEmail" style="display: none;"></i><small class="help-block"
        data-bv-validator="emailAddress" data-bv-for="txtEmail" data-bv-result="NOT_VALIDATED" style="display: none;">The email is not valid</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtEmail"
        data-bv-result="NOT_VALIDATED" style="display: none;">Your email address is required</small></div>
  </div>
  <div class="form-group has-feedback">
    <label for="txtPhone" class="col-sm-3 control-label">Phone Number</label>
    <div class="col-sm-9"><input type="text" class="form-control" id="txtPhone" name="txtPhone" placeholder="Your phone number" data-bv-notempty="true" data-bv-notempty-message="Your phone number is required"
        data-bv-field="txtPhone"><i class="form-control-feedback" data-bv-icon-for="txtPhone" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtPhone" data-bv-result="NOT_VALIDATED"
        style="display: none;">Your phone number is required</small></div>
  </div>
  <h3><i class="fa fa-fw fa-location-arrow"></i> Billing Address</h3>
  <div class="form-group has-feedback">
    <label for="txtGooglePlaces" class="col-sm-3 control-label">Address Search</label>
    <div class="col-sm-9"><input type="text" class="form-control pac-target-input" id="txtGooglePlaces" name="txtGooglePlaces" placeholder="Start typing to find your billing address" data-bv-notempty="true"
        data-bv-notempty-message="Billing address is required" autocomplete="off" data-bv-field="txtGooglePlaces"><i class="form-control-feedback" data-bv-icon-for="txtGooglePlaces" style="display: none;"></i><small class="help-block"
        data-bv-validator="notEmpty" data-bv-for="txtGooglePlaces" data-bv-result="NOT_VALIDATED" style="display: none;">Billing address is required</small></div>
  </div>
  <div id="billingAutofillFields" class="hide">
    <div class="form-group has-feedback">
      <label for="txtAddress" class="col-sm-3 control-label">Street Address</label>
      <div class="col-sm-9"><input type="text" class="form-control" id="txtAddress" name="txtAddress" placeholder="" data-bv-notempty="true" data-bv-notempty-message="The street address is required"
          data-bv-field="txtAddress"><i class="form-control-feedback" data-bv-icon-for="txtAddress" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtAddress" data-bv-result="NOT_VALIDATED"
          style="display: none;">The street address is required</small></div>
    </div>
    <div class="form-group has-feedback">
      <label for="txtCity" class="col-sm-3 control-label">City</label>
      <div class="col-sm-9"><input type="text" class="form-control" id="txtCity" name="txtCity" placeholder="" data-bv-notempty="true" data-bv-notempty-message="The city is required"
          data-bv-field="txtCity"><i class="form-control-feedback" data-bv-icon-for="txtCity" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCity" data-bv-result="NOT_VALIDATED"
          style="display: none;">The city is required</small></div>
    </div>
    <div class="form-group has-feedback">
      <label for="txtCountry" class="col-sm-3 control-label">Country</label>
      <div class="col-sm-9"><input type="text" class="form-control" id="txtCountry" name="txtCountry" placeholder="" data-bv-notempty="true" data-bv-notempty-message="The country is required"
          data-bv-field="txtCountry"><i class="form-control-feedback" data-bv-icon-for="txtCountry" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCountry" data-bv-result="NOT_VALIDATED"
          style="display: none;">The country is required</small></div>
    </div>
    <div class="form-group has-feedback">
      <label for="txtState" class="col-sm-3 control-label">State</label>
      <div class="col-sm-3"><input type="text" class="form-control" id="txtState" name="txtState" placeholder=""></div>
      <label id="label_txtPostalCode" for="txtPostalCode" class="col-sm-3 control-label">Zip / Postal Code</label>
      <div class="col-sm-3"><input type="text" class="form-control" id="txtPostalCode" name="txtPostalCode" placeholder="" data-bv-notempty="true" data-bv-notempty-message="The zip / postal code is required"
          data-bv-field="txtPostalCode"><i class="form-control-feedback" data-bv-icon-for="txtPostalCode" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtPostalCode" data-bv-result="NOT_VALIDATED"
          style="display: none;">The zip / postal code is required</small></div>
    </div>
  </div>
  <h3><i class="fa fa-fw fa-credit-card"></i> Credit Card Details</h3>
  <div class="form-group has-feedback">
    <label for="txtCCname" class="col-sm-3 control-label">Name on Card</label>
    <div class="col-sm-9"><input type="text" class="form-control" id="txtCCname" name="txtCCname" placeholder="Name on Card" autocomplete="off" data-bv-notempty="true" data-bv-notempty-message="The name on credit card is required"
        data-bv-field="txtCCname"><i class="form-control-feedback" data-bv-icon-for="txtCCname" style="display: none;"></i><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCCname" data-bv-result="NOT_VALIDATED"
        style="display: none;">The name on credit card is required</small></div>
  </div>
  <div class="form-group has-feedback">
    <label for="txtCCnumber" class="col-sm-3 control-label">Credit Card Number</label>
    <div class="col-sm-9"><input type="text" class="form-control numeric-only" id="txtCCnumber" name="txtCCnumber" inputmode="numerical" placeholder="Credit Card Number" autocomplete="off" data-bv-notempty="true"
        data-bv-notempty-message="The credit card number is required" data-bv-creditcard="true" data-bv-creditcard-message="The credit card number is not valid"
        data-bv-field="txtCCnumber"><i class="form-control-feedback" data-bv-icon-for="txtCCnumber" style="display: none;"></i><small class="help-block" data-bv-validator="creditCard" data-bv-for="txtCCnumber" data-bv-result="NOT_VALIDATED"
        style="display: none;">The credit card number is not valid</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCCnumber" data-bv-result="NOT_VALIDATED" style="display: none;">The credit card number is
        required</small></div>
  </div>
  <div class="form-group has-feedback">
    <label for="txtCCexp" class="col-sm-3 control-label">Expiry Date</label>
    <div class="col-sm-9">
      <div class="exp-wrapper">
        <input type="text" class="exp numeric-only" id="txtCCexpMonth" name="txtCCexpMonth" maxlength="2" inputmode="numerical" placeholder="MM" autocomplete="off" data-bv-notempty="true"
          data-bv-notempty-message="The credit card expiry month is required" pattern="[0-9]*" data-bv-regexp-message="The expiry month must be in this format: MM"
          data-bv-field="txtCCexpMonth"><i class="form-control-feedback" data-bv-icon-for="txtCCexpMonth" style="display: none;"></i>
        <input type="text" class="exp numeric-only" id="txtCCexpYear" name="txtCCexpYear" maxlength="2" inputmode="numerical" placeholder="YY" autocomplete="off" data-bv-notempty="true"
          data-bv-notempty-message="The credit card expiry year is required" pattern="[0-9]*" data-bv-regexp-message="The expiry year must be in this format: YY"
          data-bv-field="txtCCexpYear"><i class="form-control-feedback" data-bv-icon-for="txtCCexpYear" style="display: none;"></i>
      </div>
      <small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCCexpMonth" data-bv-result="NOT_VALIDATED" style="display: none;">The credit card expiry month is required</small><small class="help-block" data-bv-validator="regexp"
        data-bv-for="txtCCexpMonth" data-bv-result="NOT_VALIDATED" style="display: none;">The expiry month must be in this format: MM</small><small class="help-block" data-bv-validator="stringLength" data-bv-for="txtCCexpMonth"
        data-bv-result="NOT_VALIDATED" style="display: none;">Please enter a value with valid length</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCCexpYear" data-bv-result="NOT_VALIDATED" style="display: none;">The
        credit card expiry year is required</small><small class="help-block" data-bv-validator="regexp" data-bv-for="txtCCexpYear" data-bv-result="NOT_VALIDATED" style="display: none;">The expiry year must be in this format: YY</small><small
        class="help-block" data-bv-validator="stringLength" data-bv-for="txtCCexpYear" data-bv-result="NOT_VALIDATED" style="display: none;">Please enter a value with valid length</small>
    </div>
  </div>
  <div class="form-group has-feedback">
    <label for="txtCCcvv" class="col-sm-3 control-label">CVV</label>
    <div class="col-sm-9"><input type="text" class="form-control numeric-only" id="txtCCcvv" name="txtCCcvv" maxlength="3" placeholder="CVV Code (3-4 digit security code, typically on back of card)" autocomplete="off" data-bv-notempty="true"
        data-bv-notempty-message="The credit card CVV number is required.  This 3-4 digit security code is typically found on the back for VISA and MASTERCARD, or on the front for AMEX." data-bv-cvv="true" data-bv-cvv-ccfield="txtCCnumber"
        data-bv-cvv-message="The CVV number is not valid" data-bv-field="txtCCcvv"><i class="form-control-feedback" data-bv-icon-for="txtCCcvv" style="display: none;"></i><small class="help-block" data-bv-validator="cvv" data-bv-for="txtCCcvv"
        data-bv-result="NOT_VALIDATED" style="display: none;">The CVV number is not valid</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtCCcvv" data-bv-result="NOT_VALIDATED" style="display: none;">The credit card CVV
        number is required. This 3-4 digit security code is typically found on the back for VISA and MASTERCARD, or on the front for AMEX.</small><small class="help-block" data-bv-validator="stringLength" data-bv-for="txtCCcvv"
        data-bv-result="NOT_VALIDATED" style="display: none;">Please enter a value with valid length</small></div>
  </div>
  <div class="text-center">
    <em>Le Bleu BNB can accept payment by Visa, Mastercard or American Express.</em><br><br>
    <img align="center" src="images/accepted-credit-cards.png" width="250" height="48">
  </div>
  <button type="submit" class="btn btn-green btn-lg btn-block" data-loading-text="<span class='glyphicon glyphicon-refresh spinning'></span> Submitting, please wait ..."> Submit Securely<i class="fa fa-fw fa-lock"></i>
  </button>
</form>

Text Content

SECURE PAYMENT FORM

Please use this form to securely transmit your credit card details to Le Bleu
BNB.
All information is encrypted using SSL to ensure safe transmission.


CONTACT DETAILS

Full Name
Your first name is required
Your last name is required
Email
The email is not validYour email address is required
Phone Number
Your phone number is required


BILLING ADDRESS

Address Search
Billing address is required
Street Address
The street address is required
City
The city is required
Country
The country is required
State

Zip / Postal Code
The zip / postal code is required


CREDIT CARD DETAILS

Name on Card
The name on credit card is required
Credit Card Number
The credit card number is not validThe credit card number is required
Expiry Date

The credit card expiry month is requiredThe expiry month must be in this format:
MMPlease enter a value with valid lengthThe credit card expiry year is
requiredThe expiry year must be in this format: YYPlease enter a value with
valid length
CVV
The CVV number is not validThe credit card CVV number is required. This 3-4
digit security code is typically found on the back for VISA and MASTERCARD, or
on the front for AMEX.Please enter a value with valid length
Le Bleu BNB can accept payment by Visa, Mastercard or American Express.


Submit Securely
Submission Error! There was an error submitting your information. Please try
again.


THANK YOU



Your information has been submitted successfully and securely to our staff.

We will be in contact with you soon to confirm your reservation.

Please do not hesitate to contact us if there is anything we can assist with in
the meantime!

reservations@lebleubnb.com 1-649-232-8154 lebleubnb.com

© 2024 Le Bleu BNB. All rights reserved.

secure.lebleubnb.com Open in urlscan Pro 2606:4700:3033::6815:3c61 Public Scan

Form analysis 1 forms found in the DOM

POST process-form.php

Text Content

secure.lebleubnb.com Open in urlscan Pro
2606:4700:3033::6815:3c61 Public Scan

Form analysis
1 forms found in the DOM